الفهرس 
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Abstract
The kidney normally plays an important role in the metabolism, degradation and excretion of thyroid hormones. CKD affects thyroid function in many ways, including low circulating thyroid hormone levels, altered peripheral hormone metabolism, insufficient binding to carrier proteins, reduced tissue thyroid hormone content and altered iodine storage in the thyroid gland.
End-stage renal disease is associated with thyroid hormone alterations which have effect on morbidity and mortality.
Malnutrition is also a common complication in hemodialysis patients which significantly affects quality of life. A reduction in thyroid function in hemodialysis patients could be a marker of malnutrition and inflammation.
So, the present study aimed to detect the association between thyroid function and nutritional status in ESRD patients on hemodialysis.
This study included (84) hemodialysis patients aged from 30 years to 80 years from Mit-Khakan Dialysis Unit during the period from May 2018 till October 2018.
All patients included in this study were subjected to history, clinical examination and laboratory investigations including serum FT3, FT4 and TSH, CBC, kidney function tests, serum albumin, serum iron, total iron binding capacity, CRP and lipid profile.
Malnutrition status was determined by subjective global assessment, malnutrition inflammation score, anthropometric measures (weight, height, BMI & MAC).
Patients‟ comorbidity status was determined using the charlson Comorbidity Index.
The mean age of the studied group was 57.42±11.09 years (range, 30 to 80 years). The mean duration of dialysis was (38.23) months. The studied groups included 39 Female (46.4%) and 45 Male (53.6%). Regarding comorbidities (41.7%) of patients had hypertension, (8.3%) had diabetes mellitus, (19%) had both hypertension and diabetes while (31%) of the studied group hadn`t neither hypertension nor diabetes. The mean CCI for studied patients was 5.54± 2.137
The mean SGA score for studied patients was 13.73±4.4 (range: 7-25), the mean MIS for studied patients was 8.02± 4.62(range 1-18), mean hormonal values of thyroid function were: TSH 2.99 ± 2.93uIU/ml (range: 0.01-17.1); FT4 1.08± 0.21 ng/dl (range: 0.65-1.62) and FT3 2.55±0.52 pg/ml (range: 1.18-3.64).
Patients with normal nutritional status were 26.2%.Patients with mild to moderate malnutrition were 69%, while patients with severe malnutrition were 4.8%.
MIS and SGA had significant negative correlation with FT3, while there was no significant correlation between them and FT4 or TSH. Serum FT3 concentration inversely correlated with age (r = -0.25, P = 0.02), CCI (r = -0.48, P = 0.0001), C-reactive protein (r = -0.46, P = 0.0001), and SGA (r = -0.49, P = 0.0001), and positively correlated with serum albumin (r = 0.47, P = 0.0001). In multivariate regression analysis, MIS was independently associated with FT3
(β, -1.36; 95% confidence interval, -2.5 to-0.2, P =0.02).